Abstract
BACKGROUND: Understanding the relationship of social support network (SSN) and attachment style to suicide attempt (SA) among US Army soldiers can inform prevention efforts. Small SSN and insecure attachment styles are associated with SAs. The current study examines the extent to which these factors may relate to SA risk during the first 2 years of military service, a period of elevated risk. METHODS: A representative sample of US Army soldiers entering service (n = 21,772) was surveyed and followed via administrative records for their first 24 months of service. Insecure attachment styles (preoccupied and dismissing) and SSN size were assessed at baseline. Administrative records identified SAs over the 2-year period of assessment. Discrete-time survival analysis examined associations of SSN and attachment style with future SA during service, adjusting for socio-demographics and service-related characteristics. RESULTS: During this period, 154 soldiers attempted suicide. Examined in a multivariable model, small SSN and insecure attachment styles were associated with increased SA risk. This persisted after accounting for previous mental health diagnosis: Small SSN (OR = 1.8 [95% CI = 1.3-2.4]); preoccupied (OR = 1.7 [95% CI = 1.1-2.8]) and dismissing (OR = 1.6 [95% CI = 1.0-2.4]) attachment. Soldiers with a small SSN consistently had higher SA risk across time in service, whereas among soldiers with a large SSN, SA risk decreased between the first and second years. Two-way interactions between attachment styles and SSN were non-significant. CONCLUSIONS: Our findings underscore the importance of understanding the impact of SSN size and attachment style on SA risk among soldiers as they enter military service, as a means to identify risk and potential interventions.